CommercialPrior AuthHigh impact
Site of Service Rules for Certain Surgeries Will Start Aug. 1, 2025
EmblemHealth·General Surgery, Orthopedics, Plastic Surgery +4 more·Provider News
Effective date
Aug 1, 2025
We identified it
Jun 20, 2026
Summary
Starting August 1, 2025, EmblemHealth will require preauthorization for certain hospital outpatient surgeries (places of service 19 and 22) for members under age 75, while removing preauthorization requirements for 303 services. The same surgeries performed in ambulatory surgery centers or physician offices will not require preauthorization.
Action Required
By August 1, 2025: Billing team must update system to require preauthorization for EmblemHealth members under age 75 when scheduling surgeries at hospital outpatient facilities (POS 19 and 22). Review the Notable Changes list for specific affected surgery codes and 303 services with removed requirements. Update scheduling workflows to direct appropriate surgeries to ASCs when possible. Contact EmblemHealth Provider Customer Service for the complete list of affected codes and to identify participating ASCs.